Remote ischaemic preconditioning and survival in noncardiac surgery: a meta-analysis of randomised trials.
Summary
Across 72 RCTs in noncardiac surgery, RIPC was associated with lower mortality (RR 0.74) and reduced postoperative stroke and shorter hospital stay versus controls. These findings support RIPC as a low-cost, noninvasive strategy for perioperative organ protection and justify a definitive multicenter RCT.
Key Findings
- Meta-analysis of 72 RCTs (n=7457) in noncardiac surgery settings.
- Mortality reduced with RIPC versus control (88/2122 vs 102/1767; RR 0.74, 95% CI 0.57–0.98; P=0.03).
- Bayesian analysis indicated a high probability of mortality benefit (RR<1).
- Secondary outcomes showed reduced postoperative stroke and shorter hospital stay.
Clinical Implications
Consider implementing standardized RIPC protocols in high-risk noncardiac surgeries as an adjunct to enhance organ protection, while awaiting confirmatory multicenter trials.
Why It Matters
First meta-analysis to link RIPC with survival benefit in noncardiac surgery with consistent secondary improvements. It may shift practice toward routine perioperative RIPC protocols.
Limitations
- Mortality data available in only 28 of 72 RCTs; potential reporting bias.
- Heterogeneity in RIPC protocols and surgical populations; possible small-study effects.
Future Directions
A large, pragmatic multicenter RCT with standardized RIPC protocols, patient-centered outcomes, and cost-effectiveness analysis is warranted.
Study Information
- Study Type
- Meta-analysis
- Research Domain
- Treatment
- Evidence Level
- I - Meta-analysis of randomized controlled trials in noncardiac surgery.
- Study Design
- OTHER